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Transcript
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Talk outline
Sleep
Functions & development
Sleep-dependent learning
Observations in ADHD
Sleep & daytime behaviour in ADHD
Sleep guidance
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Views of sleep over the years
“Enjoy the honey heavy dew of slumber”
“Sleep is the golden chain that ties health and our bodies together”
“Sleep is a criminal waste of time, and a heritage from our cave days”
“Sleep is for wimps”
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Why do we sleep?
Restoration & repair
Energy conservation
Clearing waste
Memory & Learning
Focus & well being
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A bad night’s sleep?
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Sleep, attention & behaviour in
childhood
Impaired attentional & cognitive functioning
Sustained attention task & reaction times (Sadeh et al., 2003
Alerting (Hansen et al., 2014)
Attention (Sawyer et al., 2009)
Working memory (Steenari et al., 2003)
Abstract thinking & creativity (Dahl, 1996)
Challenging behaviours & emotional problems
Increase in ADHD-trait behaviours (Beebe, 2011)
Emotional & externalising problems (Gregory & O’Connor, 2002)
Internalising problems (Alfano et al., 2009)
Anxiety (Hansen et al., 2014)
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ADHD & sleep problems
Sleep problems observed in 25-50% of children with ADHD Common sleep problems in ADHD
Initiating & maintaining sleep Bedtime resistance & Sleep onset delay Increased nocturnal movements Daytime sleepiness
Sleep disturbance worsens ADHD symptomatology Experimental restriction of sleep has negative effect on attention capacity Therapeutic interventions for sleep problems in ADHD improve ADHD
symptomatology, classroom behaviours & WM task performance
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Biological mechanisms underlying poor
sleep in ADHDSleep/wake regulation
HPA axis
Brain regions most involved in regulation of arousal and attention are major sites implicated in ADHD pathophysiology
Hormones associated with disturbed sleep and stress response display atypical fluctuations in ADHD
Dysregulation of wake-promoting neurotransmitters (Norepinephrine & Dopamine) underlie core deficits
in ADHD
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Sleep-dependent learning:
What is it?The observation that memory is enhanced on a range of tasks following a night’s sleep
“Gold” “Tea”
“Cake” “Seat”Wake group
Sleep group
Sleep group remember more
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Sleep-dependent learning:
What is it?The observation that memory is enhanced on a range of tasks following a night’s sleep
Word pair learning
Nonsense syllables
Object locations
Short stories
Finger sequence
tapping
Mirror tracing tasks
Visual texture
Declarative memory
Procedural memory
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Consolidation of new information takes place mainly, and most effectively, at night
Zzz
ENCODE CONSOLIDATE RECALL
Gold - tea Gold - teaGold - tea
Gold - tea
Gold - tea
Gold - tea
Gold - tea
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Sleep that is rich in slow waves supports declarative memory consolidation
(Image taken from Wilhelm, Prehn-Kristensenc, & Born, 2012)
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Sleep-dependent learning in
children without ADHD
Data from Backhaus et al. (2008)
“Gold” “Tea”
“Cake” “Seat”
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Sleep-dependent learning in
children without ADHDDeclarative memory
Vocabulary: 7-12 year olds
Non-word learning: 6-11 year olds
Face recognition: 6-11 year olds
Digit span memory: 9-12 year olds
MEMORY GAINS RELATED TO THEIR SLOW WAVE SLEEP PATTERNS
Procedural memory
NO ENHANCEMENT
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Sleep-dependent learning in
children with ADHDDeclarative memory
MARKED REDUCTION IN SLEEP-DEPENDENT ENHANCEMENT
Picture recognition
Probabilistic learning tasks
Procedural memory
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Sleep-dependent learning in
children with ADHD
Images from Prehn-Kristensen et al. (2011a)
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Sleep-dependent learning in
children with ADHDDeclarative memory
MARKED REDUCTION IN SLEEP-DEPENDENT ENHANCEMENT
Picture recognition
Probabilistic learning tasks
MEMORY GAINS UNRELATED TO SWS PATTERNS
Procedural memory
SLEEP-DEPENDENT MEMORY GAINS FOR PROCEDURAL TASKS
Finger tapping sequenced tasks
Motor memory task
MEMORY GAINS ARE RELATED TO SLEEP ARCHITECTURE
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Sleep-dependent learning in
children with ADHD
Images & data on following slide from Prehn-Kristensen et al. (2011b)
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Sleep-dependent learning in
children with ADHDDeclarative memory
MARKED REDUCTION IN SLEEP-DEPENDENT ENHANCEMENT
Picture recognition
Probabilistic learning tasks
MEMORY GAINS UNRELATED TO SWS PATTERNS
Procedural memory
SLEEP-DEPENDENT MEMORY GAINS FOR PROCEDURAL TASKS
Finger tapping sequenced tasks
Motor memory task
MEMORY GAINS ARE RELATED TO SLEEP ARCHITECTURE
WHY??
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Sleep that is rich in slow waves supports declarative memory consolidation
Images from Ringli et al. (2014)
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Sleep that is rich in slow waves supports declarative memory consolidation
Frontal dysfunction associated with ADHD may disrupt this process
As a consequence, sleep preferentially benefits procedural memories in ADHD
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Boosting slow oscillations during SWS improves declarative memory consolidation in ADHD
Images from Prehn-Kristensen et al. (2014)
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Sleep & daytime functioning in
ADHD
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Sleep & daytime functioning in
ADHD
Impaired attentional & cognitive functioning
Sustained attention task & reaction times (Sadeh et al., 2003
Alerting (Hansen et al., 2014)
Attention (Sawyer et al., 2009)
Working memory (Steenari et al., 2003)
Abstract thinking & creativity (Dahl, 1996)
Challenging behaviours & emotional problems
Increase in ADHD-trait behaviours (Beebe, 2011)
Emotional & externalising problems (Gregory & O’Connor, 2002)
Internalising problems (Alfano et al., 2009)
Anxiety (Hansen et al., 2014)
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Sleep & daytime functioning in
ADHD
TD Poor sleep CPRS ADHD-like behaviour
ADHD Poor sleep CPTPoor
sustained attention
Sleep disturbances negatively impacts both childhood populations but in distinct ways
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Sleep & daytime functioning in
ADHD: Therapeutic interventionsBehavioural sleep intervention shows lasting improvements in:
(Hiscock et al., 2015; N=244, children with ADHD + sleep problems)Parent-reported sleep; ADHD symptom severity; Quality of life; daily functioning & behaviourTeacher-reported classroom behaviour; attendance & working memory Care-giver work attendance & mental health (at 3 months)
Other behavioural sleep interventions have shown:Improved psychosocial functioning (Keshavarzi et al., 2014)Psychosocial health (Corkum et al., 2016)
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Good sleep guide
Establish a routine and stick to it!
Make the room a sleep havenKeep it cool, quiet, dark Let in the morning sunlight as a signal to the body
Keep the bedroom media-freeLimit screen-time an hour before bedAvoid exciting video games/tv programmes an hour before bed
Be aware of caffeinated or sugary food/drinksAvoid caafeine after 3pm
Exercise regularly, but not before bedtime
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Good sleep guide:
A typical routine1. Have a light snack2. Take a bath3. Put on pyjamas4. Brush teeth5. Read a story6. Make the room quiet, dark and cool7. Put your child into bed8. Say goodnight and leave
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Good sleep guide:
How many hours to aim for
Age Hours of sleep
0-2 months 10.5-18
2-12 months 14-15
1-3 years 12-14
3-5 years 11-13
5-12 years 10-11
13-18 years 9-10
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Conclusions
Sleep is important so priorit ise it !
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Thank you
Dr. Frances [email protected]@FranKnightLILAS
Dr. Dagmara DimitriouLiLAS info:
lilaslab.weebly.comEmail: [email protected]@LILAS_Lab
mailto:[email protected]:[email protected]
Sleep-dependent learning (and daytime functioning) in ADHDTalk outlineViews of sleep over the yearsSlide Number 4Slide Number 5Why do we sleep?A bad night’s sleep?Sleep, attention & behaviour in childhoodADHD & sleep problemsBiological mechanisms underlying poor sleep in ADHDSleep-dependent learning:�What is it?Sleep-dependent learning:�What is it?Slide Number 13Slide Number 14Slide Number 15Sleep-dependent learning in children without ADHDSleep-dependent learning in children without ADHDSleep-dependent learning in children with ADHDSleep-dependent learning in children with ADHDSleep-dependent learning in children with ADHDSleep-dependent learning in children with ADHDSlide Number 22Sleep-dependent learning in children with ADHDSlide Number 24Slide Number 25Boosting slow oscillations during SWS improves declarative memory consolidation in ADHDSleep & daytime functioning in ADHDSleep & daytime functioning in ADHDSleep & daytime functioning in ADHDSleep & daytime functioning in ADHD: Therapeutic interventionsGood sleep guideGood sleep guide:�A typical routineGood sleep guide:�How many hours to aim forConclusionsThank you
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